CPT 0671T: ICD-10 codes that support medical necessity
These ICD-10-CM diagnoses support medical necessity for CPT 0671T under Medicare coverage policies (LCDs, NCDs, and Billing & Coding articles). Billing CPT 0671T with a diagnosis that isn't covered typically denies as CARC 50 — not medically necessary.
National approximation. Coverage varies by MAC and state — confirm against the specific LCD/NCD and article that applies to your jurisdiction and date of service.
| ICD-10 | Description |
|---|---|
| H40.10X1 | Unspecified open-angle glaucoma, mild stage |
| H40.10X2 | Unspecified open-angle glaucoma, moderate stage |
| H40.10X3 | Unspecified open-angle glaucoma, severe stage |
| H40.10X4 | Unspecified open-angle glaucoma, indeterminate stage |
| H40.1111 | Primary open-angle glaucoma, right eye, mild stage |
| H40.1112 | Primary open-angle glaucoma, right eye, moderate stage |
| H40.1113 | Primary open-angle glaucoma, right eye, severe stage |
| H40.1114 | Primary open-angle glaucoma, right eye, indeterminate stage |
| H40.1121 | Primary open-angle glaucoma, left eye, mild stage |
| H40.1122 | Primary open-angle glaucoma, left eye, moderate stage |
| H40.1123 | Primary open-angle glaucoma, left eye, severe stage |
| H40.1124 | Primary open-angle glaucoma, left eye, indeterminate stage |
| H40.1131 | Primary open-angle glaucoma, bilateral, mild stage |
| H40.1132 | Primary open-angle glaucoma, bilateral, moderate stage |
| H40.1133 | Primary open-angle glaucoma, bilateral, severe stage |
| H40.1134 | Primary open-angle glaucoma, bilateral, indeterminate stage |
| H40.1211 | Low-tension glaucoma, right eye, mild stage |
| H40.1212 | Low-tension glaucoma, right eye, moderate stage |
| H40.1213 | Low-tension glaucoma, right eye, severe stage |
| H40.1214 | Low-tension glaucoma, right eye, indeterminate stage |
| H40.1221 | Low-tension glaucoma, left eye, mild stage |
| H40.1222 | Low-tension glaucoma, left eye, moderate stage |
| H40.1223 | Low-tension glaucoma, left eye, severe stage |
| H40.1224 | Low-tension glaucoma, left eye, indeterminate stage |
| H40.1231 | Low-tension glaucoma, bilateral, mild stage |
| H40.1232 | Low-tension glaucoma, bilateral, moderate stage |
| H40.1233 | Low-tension glaucoma, bilateral, severe stage |
| H40.1234 | Low-tension glaucoma, bilateral, indeterminate stage |
| H40.1311 | Pigmentary glaucoma, right eye, mild stage |
| H40.1312 | Pigmentary glaucoma, right eye, moderate stage |
| H40.1313 | Pigmentary glaucoma, right eye, severe stage |
| H40.1314 | Pigmentary glaucoma, right eye, indeterminate stage |
| H40.1321 | Pigmentary glaucoma, left eye, mild stage |
| H40.1322 | Pigmentary glaucoma, left eye, moderate stage |
| H40.1323 | Pigmentary glaucoma, left eye, severe stage |
| H40.1324 | Pigmentary glaucoma, left eye, indeterminate stage |
| H40.1331 | Pigmentary glaucoma, bilateral, mild stage |
| H40.1332 | Pigmentary glaucoma, bilateral, moderate stage |
| H40.1333 | Pigmentary glaucoma, bilateral, severe stage |
| H40.1334 | Pigmentary glaucoma, bilateral, indeterminate stage |
| H40.1411 | Capsular glaucoma with pseudoexfoliation of lens, right eye, mild stage |
| H40.1412 | Capsular glaucoma with pseudoexfoliation of lens, right eye, moderate stage |
| H40.1413 | Capsular glaucoma with pseudoexfoliation of lens, right eye, severe stage |
| H40.1414 | Capsular glaucoma with pseudoexfoliation of lens, right eye, indeterminate stage |
| H40.1421 | Capsular glaucoma with pseudoexfoliation of lens, left eye, mild stage |
| H40.1422 | Capsular glaucoma with pseudoexfoliation of lens, left eye, moderate stage |
| H40.1423 | Capsular glaucoma with pseudoexfoliation of lens, left eye, severe stage |
| H40.1424 | Capsular glaucoma with pseudoexfoliation of lens, left eye, indeterminate stage |
| H40.1431 | Capsular glaucoma with pseudoexfoliation of lens, bilateral, mild stage |
| H40.1432 | Capsular glaucoma with pseudoexfoliation of lens, bilateral, moderate stage |
| H40.1433 | Capsular glaucoma with pseudoexfoliation of lens, bilateral, severe stage |
| H40.1434 | Capsular glaucoma with pseudoexfoliation of lens, bilateral, indeterminate stage |
Frequently asked questions
Which ICD-10 codes support medical necessity for CPT 0671T?
Medicare coverage policies (LCDs/NCDs and Billing & Coding articles) list 52 ICD-10 diagnosis codes that support medical necessity for CPT 0671T. The covered codes are listed on this page. Coverage varies by MAC/state — always confirm against the policy that applies to you.
What is a medical-necessity (LCD/NCD) crosswalk?
A claim whose procedure isn't supported by a covered diagnosis denies as "not medically necessary" (CARC 50). CMS coverage policies define which diagnoses justify a procedure; this page is the ICD-10 → CPT 0671T view of that relationship.
More free billing tools: all crosswalks · NCCI edits · Medicare fees · denial codes
Informational only, not coding, billing, or legal advice. Based on CMS Medicare Coverage Database data; verify the current LCD/NCD for your MAC before billing.
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